Ann Thorac Surg 2009;87:952-954. doi:10.1016/j.athoracsur.2008.07.030
© 2009 The Society of Thoracic Surgeons
Case Reports
Lobectomy of Second Primary Cancer in Survivor of Small Cell Lung Cancer With Brain Metastasis
Yusuke Nakamura, MDa,*,
Masayuki Iwazaki, MDa,
Fumio Maitani, MDb,
Yoshimasa Inoue, MDa,
Yoshihiro Hayashi, MDd,
Akio Hasegawa, MDc,
Hiroshi Inoue, MDa
a Division of Thoracic Surgery, Department of Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
b Department of General Thoracic Surgery, Odawara Municipal Hospital, Odawara, Kanagawa, Japan
c Department of Pathology and Laboratory Medicine, Odawara Municipal Hospital, Odawara, Kanagawa, Japan
d Department of Respiratory Medicine, Yamachika Memorial General Hospital, Odawara, Japan
Accepted for publication July 9, 2008.
* Address correspondence to Dr Nakamura, Division of Thoracic Surgery, Department of Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan (Email: yus_naka{at}yahoo.co.jp).
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Abstract
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Resection of a second primary nonsmall cell lung carcinoma in a long-term survivor of small cell lung carcinoma with brain metastasis is reported. The patient had squamous cell carcinoma as the second primary tumor and underwent lobectomy with node dissection. He was alive 79 months after the initial diagnosis of the small cell carcinoma, 64 months after the diagnosis of the brain metastasis, and 21 months after the curative pulmonary resection for his second primary carcinoma.
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Introduction
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Development of a second primary nonsmall cell lung carcinoma in a patient previously treated for small cell lung carcinoma is well described [1–5], but reports of pulmonary resection of a second primary lung carcinoma in a survivor of small cell lung carcinoma with brain metastasis have rarely been published. A patient in whom pulmonary squamous cell carcinoma developed 42 months after successful treatment of brain metastasis from a small cell lung carcinoma is presented, and the relevant literature is reviewed.
A 73-year-old asymptomatic man was referred to Yamachika Memorial General Hospital for further evaluation of abnormal chest shadows that were incidentally detected on a chest roentgenogram during an annual health screening in November 2001. A computed tomographic scan revealed a 22-mm nodule in the right lung (S1) and enlargement of the pre-tracheal lymph node. Transbronchial lung biopsy of the lesion in S1 revealed small cell carcinoma (Fig 1). The patient was treated with eight cycles of combination chemotherapy (carboplatin at area under the blood concentration time curve 5 on day 1 and etoposide at 70 mg/m2 on days 1, 2, and 3), which yielded complete remission. In February 2003, brain metastasis was detected by magnetic resonance imaging (Fig 2). The patient was treated by whole brain radiotherapy at 30 Gy, which resulted in complete remission. The patient did well until August 2006, when a nodular shadow was detected in the left basal bronchus. Transbronchial biopsy of this nodule revealed squamous cell carcinoma. In September 2006, the patient who was 78 years old was referred to Odawara Municipal Hospital for a left lower lobectomy with hilar node dissection. A 20-mm lung tumor was resected, which proved to be a well-differentiated squamous cell carcinoma (Fig 3). The patient was alive without evidence of recurrence 79 months after the diagnosis of the small cell lung carcinoma, 64 months after the diagnosis of the brain metastasis, and 21 months after the curative pulmonary resection for squamous cell carcinoma.
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Fig 1. Transbronchial lung biopsy specimen showing small cell carcinoma. (Hematoxylin and eosin stain; x100.)
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Fig 3. The second primary was a well-differentiated squamous cell carcinoma. (Hematoxylin and eosin stain; x100.)
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Comment
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The main reason for presenting this case of successful surgical treatment of a second primary lung carcinoma in a long-term survivor after treatment for small cell lung carcinoma with brain metastasis is that it is a very rare case indeed. Some reports of pulmonary resection of a second primary lung carcinoma in a survivor of small cell lung carcinoma have been published [1–5]. However, reports of surgical resection of a second primary nonsmall cell lung carcinoma in a survivor of small cell lung carcinoma with brain metastasis are very rare. Our search of the literature revealed no such reports and we believe that this is the first report of such a case.
In 1984, Craig and associates [1] published the first case report of surgical resection of a second primary lung carcinoma in a survivor of small cell lung carcinoma; this patient remained alive 7 months after the curative pulmonary resection. Subsequently, several such reports have been published [2–5]. In 1995, Johnson and associates [2] published the very detailed report of second primary carcinomas after treatment for small cell lung carcinomas; in this article, among 578 patients of small cell lung carcinoma, 62 were cancer-free 2 years after initiation of therapy and nonsmall cell lung carcinoma developed in 15 of these 62. Of these 15, 4 underwent surgical resection, but 3 of these 4 had incomplete resection, and none of these 4 previously had brain metastasis. This supports evidence that our present article is the first report of such a case in that surgical resection of a second primary nonsmall cell lung carcinoma in a survivor of small cell lung carcinoma with brain metastasis was performed. The most recent article reviewing surgical resection of a second primary carcinoma after treatment for small cell lung carcinoma was reported by Smythe and associates [3] in 2001; in this article, among 1,404 patients of small cell lung carcinoma, 29 underwent therapy for a second primary lung carcinoma, and 10 of these 29 cases underwent surgical resection. Of these 10 patients, 9 underwent wedge resection, which yielded poor survival (median survival, 24.53 months; 5-year survival rate, 23%). On the other hand, in 1993, Inoue and associates [4] reported lobectomy with mediastinal node dissection for a second primary lung carcinoma in a survivor of small cell lung carcinoma, and the patient remained alive 54 months after the resection. In 1999, Riquet and associates [5] reported pneumonectomy with mediastinal node dissection for a second primary lung carcinoma in a survivor of small cell lung carcinoma, and the patient remained alive 4 years after surgery.
Based on the previously mentioned literature, we performed a lobectomy (not a wedge resection) in our present case, and there is the possibility of long-term survival after the resection. We recommend that whenever it is possible, on pulmonary function, medical condition, and anatomical condition, of course, a lobectomy should be performed for a second primary lung carcinoma in survivors of small cell lung carcinoma.
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References
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- Craig J, Powell B, Muss HB, Kawamoto E, Breyer R. Second primary bronchogenic carcinoma after small cell carcinoma: report of two cases and review of the literature Am J Med 1984;76:1013-1020.[Medline]
- Johnson BE, Linnoila RI, Williams JP, et al. Risk of second aerodigestive cancers increases in patients who survive free of small-cell lung cancer for more than 2 years J Clin Oncol 1995;13:101-111.[Abstract/Free Full Text]
- Smythe WR, Estrera AL, Swisher SG, et al. Surgical resection of non-small cell carcinoma after treatment for small cell carcinoma Ann Thorac Surg 2001;71:962-966.[Abstract/Free Full Text]
- Inoue H, Iwasaki M, Ogawa J, Shohtsu A, Shioya S, Osamura Y. Surgical resection of a second primary lung carcinoma in a survivor of small cell carcinoma Ann Thorac Surg 1993;56:1160-1161.[Abstract/Free Full Text]
- Riquet M, Barthes FLP, Chehab A, Danel C. Adenosquamous carcinoma occurring after small cell lung cancer: a 10 year follow-up Eur J Cardiothorac Surg 1999;16:384-386.[Abstract/Free Full Text]
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Abstract
Introduction
